Referral of Patients from the Gaza Strip, February, 2011 1

––

Permit applications for patient referrals through Erez

During February 2011, the Israeli District Liaison Office (DCL) processed 899 patient applications for permits to

cross Erez checkpoint to access hospitals in East Jerusalem, the West Bank, Israel and Jordan (see Table 1).

This compares to 935 processed applications in January 2011.

Table 1: District Liaison Office decisions on permit requests to cross Erez

(February 2011, disaggregated by age and sex)

Age group Total Approved Denied Delayed Did not

cross

despite

approval

Out of which

called for GSS

interrogation

M F M F M F M F M F M F

0 - 3 80 51 78 49 0 0 2 2 0 0 0 0

4 - 17 108 73 102 68 0 0 6 5 0 0 0 0

18 - 40 129 107 77 90 15 1 37 16 5 2 0 0

41 - 60 136 110 115 107 4 1 17 2 4 0 0 0

Over 60 58 47 54 44 0 0 4 3 0 0 0 0

Sub-total 511 388 426 358 19 2 66 28 9 2 0 0

Total 899 784 21 94 11 0

87% of all applications were approved in February 2011 (see Figure 1). This is the highest approval rate since

January 2008.

2% of all applications (21 patients) were denied permission to cross Erez checkpoint. Another 11% (94 patients,

including 15 children) had their applications delayed. In January 2011 the percentage of delayed patients was

substantially higher (18%).

Summary for February 2011

87% of all applications to cross Erez checkpoint were approved in February. The

remaining 13% of patients had their applications denied or delayed and,

subsequently, missed their hospital appointment.

A 19-year-old man suffering from kidney problems who had a valid permit to cross

Erez checkpoint was detained by the Israeli authorities there.

Rafah crossing into Egypt was closed until 20 February. As such, the number of

patients travelling to Egyptian hospitals was substantially lower than in previous

months.

MONTHLY REPORT Referral of Patients from the Gaza Strip

February 2011

occupied Palestinian territory

Referral of Patients from the Gaza Strip, February, 2011 2

Of the 94 patients whose applications were delayed by the Israeli authorities, 11 (12%) were called for

interrogation by the Israeli intelligence services, known as General Security Services (GSS). 4 of these patients

did not attend the interrogation, 6 patients were asked to submit a new application and one received approval to

exit through Erez crossing.

66% of delayed patients faced delays of more than a week. Delayed patients generally miss their hospital

appointments. In most cases they have to seek new appointments and submit new applications for a permit to

cross Erez checkpoint. Delays in processing applications can be critical for patients who are waiting for urgent

medical treatment. Some may die while waiting for permission to access the medical facility they have been

referred to. Since the beginning of the year 2009, 35 patients have died before being able to access the

hospital they had been referred to.

Destinations and reasons for referral

During February 2011, the Referral Abroad Department (RAD) of the Palestinian Ministry of Health (MoH)

approved and issued 1,285 referral documents compared with 1,784 in January. RAD found that 447 patients

were able to receive appropriate treatment within the Gaza Strip, in either NGO or private hospitals.

The remaining 838 patients had to leave Gaza in order to be treated in hospitals in East Jerusalem (33%), Israel

(31%), Egypt (22%), the West Bank (10%) and Jordan (3%) (see Figure 2). The total number of cases referred to

hospitals outside Gaza was the lowest since February 2010.

Rafah border crossing was closed for the first 19 days of February. It reopened on 20 February. As a direct

result, the share of patients referred to Egypt this month decreased to less than half the rate for January 2011

(46%). While Rafah was closed, the number of patient permit applications to cross through Erez increased1.

In order to avoid being denied access or being delayed by the Israeli authorities at Erez checkpoint, many

patients prefer to be referred to Egypt. This is particularly true for men aged 18-40, who have only a 50% chance

of receiving an Israeli-issued permit2. Many patients also express fear of being arrested by the Israeli authorities.

1 For details of the impact of Rafah closure during the first half of February 2011 see: “Update on Rafah Closure: Impact on Referral of

Patients from the Gaza Strip,” http://www.issuu.com/who-opt/docs/update_rad_mid-february_2011 ” 2 Figure from an upcoming WHO report.

Referral of Patients from the Gaza Strip, February, 2011 3

This fear was substantiated, for example, on 1 March 2011, when a patient carrying a valid permit, was

detained at Erez crossing. (See “19-year-old patient with valid permit detained at Erez crossing” below.)

The main reasons for referrals in February were: cardiovascular i.e. heart diseases (20%), oncology i.e. cancer

(10%), ophthalmology i.e. eye conditions (7%), orthopedics (5%) and neurosurgery (5%)3. These health

conditions accounted for 47% of all referrals from Gaza in February; however, together they made up 56% of the

total cost of referrals this month, which reached NIS 9.9 million.

Erez and Rafah crossing data for February 2011

According to the Palestinian Liaison Officer at Erez, 734 patients crossed Erez checkpoint during February 20114.

38 of them needed to be transported by ambulance. Because Palestinian ambulances are not permitted to leave

Gaza, the patients were transferred from one ambulance to another (back-to-back) at Erez checkpoint. This

compares to 709 patients, including 37 via back-to-back ambulances, in January 2011.

Rafah border crossing was closed from 30 January until 19 February (inclusive), due to the political unrest

in Egypt. During that time no patients from Gaza were able to access hospitals in Egypt. In the last ten days of

February, an estimated 200 patients managed to leave Gaza through Rafah for treatment in Egypt. This included

patients who were seeking medical treatment at their own expense and, therefore, traveled without a RAD referral

document.

3 These figures include referrals to NGO and private hospitals inside Gaza. For technical reasons it is not currently possible to provide a

separate breakdown for patients who have to leave the Gaza Strip. 4 The discrepancy between the number of permits approved (784 for February 2011) and the number of patients who crossed this same month

(734), is due to the fact that patients who have their permits approved at the end of one month might only cross the following month.

Referral of Patients from the Gaza Strip, February, 2011 4

5

5 For more details on the case of Mohammed Zorob see WHO “Update on Rafah Closure: Impact on Referral of Patients from the Gaza Strip,

” http://www.issuu.com/who-opt/docs/update_rad_mid-february_2011 and the joint press release by Al Mezan Center for Human Rights, Physicians for Human Rights and ADALAH http://www.mezan.org/en/details.php?id=11524&ddname=torture&id_dept=31&id2=9&p=center

Further information

Back issues of this report and other WHO publications are available at:

http://issuu.com/who-opt/docs

To subscribe, for questions and inquiries, please write to: rad-report@who-health.org

19-year-old patient with valid permit detained at Erez crossing

Mahdy Atef Abu Nasser, a 19-year-old man from Deir Al Balah city, was detained by the Israeli

authorities at Erez crossing despite carrying a valid permit.

Mr. Abu Nasser is suffering from kidney problems and passes blood in his urine. He was being

treated at Deir Al Balah’s Aqsa Hospital in the central Gaza Strip. Since the start of 2011,

however, Mr. Abu Nasser’s condition had deteriorated and his doctor had decided to refer him to

Augusta Victoria Hospital in East Jerusalem. He scheduled an appointment there for 1 March in

order to undergo medical examinations and treatment.

The Israeli authorities approved Mr. Abu Nasser’s permit application on 1 March at 1pm. The

Palestinian DCO immediately informed him and Mr. Abu Nasser went to Erez accompanied by his

mother.

On arrival at Erez checkpoint, Mahdy Atef Abu Nasser was called for interrogation by the Israeli

General Security Services and was, subsequently, detained. His mother was asked to return

home without being given any reason for her son’s detention.

Mr. Abu Nasser’s family contacted Al Mezan Center for Human Rights. On 3 March, the family

was informed that the Al Mezan lawyer was refused access to the detainee.

Patient companion detained at Erez crossing

The detention of Mr. Abu Nasser comes two weeks after the detention of Mohammed Zorob. On

15 February 2011 Mr. Zorob, who was accompanying his sister Hanan in an intensive care unit

ambulance through Erez crossing, was interrogated and detained by the Israeli authorities despite

having a valid permit. According to Al Mezan Center for Human Rights, Mr. Zorob had already

accompanied his sick sister five times to hospitals in Israel. He had also donated bone marrow to

her5.

Referral of Patients from the Gaza Strip, February, 2011 5

Annex 1: Historic data

6 The percentage rates for patients called for an interrogation with GSS are calculated from the total number of permit applications submitted.

District Liaison Office decisions on permit requests to cross Erez (total number and % per decision for given period)

Period Total Approved Denied Delayed

Out of which called for GSS interrogation

6

Jan 2010 1081 845 24 212 85

78.2% 2.2% 19.6% 7.9%

Feb 2010 979 767 25 187 38

78.3% 2.6% 19.1% 3.9%

Mar 2010 1029 780 23 226 30

75.8% 2.2% 22.0% 2.9%

Apr 2010 1047 760 40 247 42

72.6% 3.8% 23.6% 4.0%

May 2010 1225 894 155 176 52

73.0% 12.7% 14.4% 4.2%

Jun 2010 1090 864 134 92 61

79.3% 12.3% 8.4% 5.6%

Jul 2010 947 789 95 63 31

83.3% 10.0% 6.7% 3.3%

Aug 2010 919 770 87 62 20

83.8% 9.5% 6.7% 2.2%

Sep 2010 626 532 14 80 15

85.0% 2.2% 12.8% 22.4%

Oct 2010 976 744 21 211 6

76.2% 2.2% 21.6% 0.6%

Nov 2010 821 650 17 154 13

79.2% 2.1% 18.8% 1.6%

Dec 2010 895 690 15 190 20

77.1% 1.7% 21.2% 2.2%

Jan 2011 935 744 22 169 15

79.6% 2.4% 18.1% 1.6%

Feb 2011 899 784 21 94 11

87.2% 2.3% 10.5% 1.2%

2010 11635 9085 650 1900 413

78.1% 5.6% 16.3% 3.5%

2009 7514 5130 149 2235 636

68.3% 2.0% 29.7% 8.5%

Referral of Patients from the Gaza Strip, February, 2011 6

Referrals out of Gaza by geographic location

(total numbers and % per destination for given period)

Period West Bank East

Jerusalem Egypt Jordan Israel

Jan 2010 125 327 172 11 189

15.2% 39.7% 20.9% 1.3% 22.9%

Feb 2010 148 327 167 21 168

17.8% 39.4% 20.1% 2.5% 20.2%

Mar 2010 87 364 204 10 205

10.0% 41.8% 23.4% 1.1% 23.6%

Apr 2010 97 299 280 7 183

11.2% 34.5% 32.3% 0.8% 21.1%

May 2010 176 342 209 9 230

18.2% 35.4% 21.6% 0.9% 23.8%

Jun 2010 125 301 443 10 186

11.7% 28.3% 41.6% 0.9% 17.5%

Jul 2010 140 253 470 14 203

13.0% 23.4% 43.5% 1.3% 18.8%

Aug 2010 129 323 388 11 257

11.6% 29.2% 35.0% 1.0% 23.2%

Sep 2010 99 212 414 8 206

10.5% 22.6% 44.1% 0.9% 21.9%

Oct 2010 114 285 496 24 189

10.3% 25.7% 44.8% 2.2% 17.1%

Nov 2010 108 246 429 10 216

10.7% 24.4% 42.5% 1.0% 21.4%

Dec 2010 124 238 537 15 211

11.0% 21.2% 47.7% 1.3% 18.8%

Jan 2011 70 294 531 22 246

6.0% 25.3% 45.7% 1.9% 21.2%

Feb 2011 86 280 185 27 260

10.3% 33.4% 22.1% 3.2% 31.0%

2010 1472 3517 4209 150 2443

12.5% 29.8% 35.7% 1.3% 20.7%

2009 1327 2453 3203 364 1158

15.6% 28.8% 37.7% 4.3% 13.6%